左卡尼汀治疗血液透析患者尿毒症性周围神经病变的Meta分析

    A Meta-analysis of the treatment of uremic peripheral neuropathy with levocarnitine combined with hemodialysis

    • 摘要: 目的 客观评价比较左卡尼汀联合血液透析与单用血液透析治疗尿毒症性周围神经病变的临床疗效。方法 计算机检索中文数据库包括:中国知网、万方数据库、维普数据库和中国生物医学文献数据库;外文数据库包括:PUBMED、EMBASE、Cochrane图书馆等,检索时间从建库至2017年11月18日,同时手工检索相应中文文献。收集以左卡尼汀联合血液透析为干预措施治疗尿毒症性周围神经病变的随机对照试验(RCT),根据纳入与排除标准筛选所检索的文献,对纳入的文献进行数据提取、质量评价并应用Rev Man 5.3软件对所纳入文章的数据进行Meta分析。结果 经评价者严格筛选后,共纳入9篇国内符合标准的RCT,样本量共计756例患者。Meta分析结果显示,左卡尼汀联合血液透析治疗尿毒症性周围神经病变的显效率明显高于单用血液透析治疗(RR=2.13,95%CI1.69~2.69,P<0.01),且经左卡尼汀联合血液透析治疗后患者的感觉神经传导速度与单用血液透析治疗效果相比有明显提高(RR=6.92,95%CI5.77~8.08,P<0.01)。结论 对于我国尿毒症患者,左卡尼汀联合血液透析与单用血液透析治疗尿毒症性周围神经病变相比,临床疗效更好,而且方法简单,可操作性强,但由于进行Meta分析的文献较少,样本量及文献质量不高,故仍需更多大样本、高质量研究的RCT进一步证实。

       

      Abstract: Objective To evaluate the clinical efficacy of levocarnitine combined with hemodialysis versus hemodialysis alone in the treatment of uremic peripheral neuropathy. Methods The randomized clinical trials (RCTs) of levocarnitine combined with hemodialysis versus hemodialysis in uremic peripheral neuropathy were searched from CNKI, WanFang Date, WeiPu Date, CBM, PUBMED, EMBASE, Cochrane Library, from the inception to November 18, 2017. Meanwhile, the corresponding Chinese literature was also retrieved manually. Meta-analysis was performed using RevMan 5.3 software offered by Cochrane Library. Results After strict selection by the evaluator, our review included 9 RCTs involving 756 patients in Chinese. Meta-analysis demonstrated that the efficacy of levocarnitine combined with hemodialysis in the treatment of uremic peripheral neuropathy was significantly higher than hemodialysis alone (RR=2.13, 95%CI 1.69-2.69, P<0.01), besides the sensory conduction velocity (SCV) was also significantly improved (RR=6.92, 95%CI 5.77-8.08, P<0.01). Conclusions Levocarnitine combined with hemodialysis is more effective than hemodialysis alone for the therapy of uremic peripheral neuropathy in Chinese patients with simple method and the maneuverability is strong, but further large scale RCTs with high quality are needed to confirm these results.

       

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